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Purpose: Marginal ulcer (MU) is well-known complication in bariatric surgery. Several studies are available in Roux-en-Y gastric bypass (RYGBP), while data on the incidence in duodenal switch (DS) is limited. We aimed to compare the incidence of MU between DS and RYGBP in a well-defined cohort and to identify associative factors. Methods: A cohort of 732 patients with BMI ≥ 48 who had undergone primary DS or RYGBP during 2008–2018 received a questionnaire concerning ulcers, PPI therapy, and smoking habits; hereafter, patient charts were reviewed. Incidence rates (IRs) for MU were calculated in our survey and on previous registered data in the national quality register for bariatric surgery (SOReg). A multivariate regression analysis was performed to identify predictive risk factors for MU. Results: After a mean follow-up of 6.1 years, 472 (64%) patients responded (47 ± 11 years old, 65% women and 42% DS). Of 41 MUs identified, 23 were endoscopically verified. Gastrointestinal bleeding, abdominal pain, and dysphagia were the most common symptoms. IR for MU was 1.4% (DS 1.3% and RYGBP 1.5%) per patient-year, compared with 0.9% according to SOReg-data. Persisting PPI treatment was seen in about three quarter of former MU patients (OR 11.2 [3.6–34.7], p < 0.001), but no other associative factors were found. Conclusion: The overall risk for MU was low, about 1% per patient-year, without difference between DS and RYGBP. Ongoing PPI treatment was frequent in many former MU patients. This study on MU after DS provides reassuring results for future bariatric surgery candidates. [ABSTRACT FROM AUTHOR]

Background: Duodenal switch is a choice of conversion when patients fail to lose or regain weight after Roux-en-Y gastric bypass (RYGB). This study aims to evaluate the effectiveness and safety of duodenal switch as a secondary operation for patients who presented with insufficient weight loss or weight regain after a RYGB.Methods: A retrospective chart review was performed on 15 patients who underwent a conversion of RYGB to single anastomosis duodeno-ileal bypass with sleeve (SADI-S) or biliopancreatic diversion with duodenal switch (BPD-DS) due to weight regain between December 31, 2013 and October 31, 2018. For the body mass index (BMI) analysis, the multilevel model for change was used.Results: Of 15 patients, 10 underwent a conversion to SADI-S, and 5 underwent a conversion to BPD-DS. Also, 7 patients underwent the conversion in two-stages, while 8 did as single-stage. One patient had a duodenal stump leak after SADI-S, and another patient had a sleeve leak after BPD-DS. One patient underwent a reoperation to increase the common channel 20 months after the conversion to BPD-DS due to malnutrition. There was no mortality. Mean percentage of total weight loss (TWL) was 18.4% at 6 months, 25.0% at 12 months, 26.4% at 18 months, and 25.7% at 24 months after the conversion. The rate of decrease in BMI was slower in SADI-S patients than in BPD-DS patients (p < 0.01), adjusting for preoperative BMI.Conclusion: Conversions of RYGB to SADI-S and BPD-DS can provide significant additional weight loss. However, complications and malnutrition can develop after the conversion, and further research is needed for evaluating safety. [ABSTRACT FROM AUTHOR]

Setting: Community, academic affiliated hospital. Objectives: In the recent years, a movement towards robotic-assisted biliopancreatic diversion with duodenal switch (BPD/DS) has reported mixed short-term outcomes. We report our 10-year experience with robotic-assisted BPD/DS in our institution. Methods: We conducted a retrospective analysis of 304 consecutive bariatric patients who had robotic or robotic-assisted BPD/DS from December 2008 to February 2018 from a single operating surgeon. Thirty 30-day and 90-day complication and readmission rates were analyzed. No patient was lost to follow-up. Results: The median age of the patients was 45 years (interquartile range (IQR) = 16; range = 20–72). Two hundred ten (69.1%) were female. The median pre-op body mass index (BMI) was 49.2 (IQR = 9; range = 34–79). Median operative time was 253.5 min (IQR = 61; range = 124–463). The median hospital length of stay (LOS) was 2 days (IQR = 2; range = 1–13). Thirty-day follow-up revealed 3 major and 20 minor events in 23 patients (7.6%) while there were 4 major and 7 minor events in 6 (2%) patients after 30 days. There were 15 (5%) readmissions within 30 days and 10 (3.2%) additional readmissions occurred past 30 days, but within 90-day period. A need for going back to operating room was observed in 4 (1.3%) patients within 30 days and an additional 5 (1.6%) needed an operation beyond 30 days, but within 90-day period. There was no anastomotic leak and no mortality recorded. Conclusion: Robotic-assisted BPD/DS is safe with low early morbidity and mortality. [ABSTRACT FROM AUTHOR]

Purpose: To study weight loss, comorbidity remission, complications, and nutritional deficits after duodenal switch (DS) and single-anastomosis DS with sleeve gastrectomy (SADI-S). Material and Methods: Retrospective review of patients submitted to DS or SADI-S for morbid obesity in a single university hospital. Results: Four hundred forty patients underwent DS (n = 259) or SADI-S (n = 181). Mean preoperative body mass index (BMI) was 50.8 ± 6.4Kg/m2. Mean follow-up was 56.1 ± 37.2 months for DS and 27.2 ± 18.9 months for SADI-S. Global mean excess weight loss was 77.4% at 2 years similar for SADI-S and DS, and 72.1% at 10 years after DS. Although early complications were similar in SADI-S and DS (13.3% vs. 18.9%, p = n.s.), long-term complications and vitamin and micronutrient deficiencies were superior after DS. Rate of comorbidities remission was 85.2% for diabetes, 63.9% for hypertension, 77.6% for dyslipidemia, and 82.1% for sleep apnea, with no differences between both techniques. In patients with initial BMI > 55 kg/m2 (n = 91), DS achieved higher percentage of BMI < 35 kg/m2 (80% vs. 50%, p = 0.025) and higher rate of diabetes remission (100% vs. 75%, p = 0050). Conclusions: DS and SADI-S showed similar weight loss and comorbidity remission rates at 2 years. In patients with initial BMI > 55 kg/m2, DS obtained better BMI control at 2 years and better diabetes remission, but more long-term complications and supplementation needs. [ABSTRACT FROM AUTHOR]

Background: Traditional duodenal switch (DS) typically leaves a short common channel and is infrequently performed in part due to increased risk of malnutrition. We compared nutritional deficiencies between DS with a moderate channel length and standard proximal Roux-en-Y gastric bypass (RYGB). Methods: We conducted a retrospective review of 61 matched pairs who underwent DS or RYGB using our institutional database; patients were matched on sex, age, race, and BMI. DS was performed with a common channel length between 120 and 150 cm. Thirty-day complications, total body weight loss (TBWL) %, and nutritional labs up to 24 months were compared using paired t test and Wilcoxon rank sum tests. Results: Weight loss was similar at each time point (all p > 0.1). DS patients had lower vitamin D levels at 6 months, lower calcium levels at 6 and 12 months, and lower hemoglobin at 12 months and otherwise equivalent (all p < 0.05). Revision was rare (1 DS; 0 RYGB). There were no differences in short-term complications (p = 0.28). Conclusion: DS with a moderate common channel length is safe with a low revision rate. Weight loss and nutritional outcomes appear to be comparable to RYGB, and it may be considered an effective RYGB alternative. [ABSTRACT FROM AUTHOR]

Insufficient weight loss is common in super-obese patients (body mass index >50) after Roux-en-Y gastric bypass (RYGB). Duodenal switch (DS) is more effective; however, it is considered to have an increased complication rate. To compare early complications (≤30 d), long-term adverse events, and quality of life (QoL) between primary DS and RYGB. Sweden. National cohort-study of super-obese patients after primary DS or RYGB in Sweden 2007 to 2017. Propensity-score matching was used to reduce confounders. Five national registers were cross-matched. The study population consisted of 333 DS and 1332 RYGB (body mass index 55 ± 5 kg/m2, 38.5 ± 11 yr, and 60.7% females). Laparoscopic approach was used in 25% of DS and 91% of RYGB. Early complications were more common after DS (15.3% versus 8.1%, P <.01), mainly because of more open surgery and related surgical site infections. During 4.6 ± 2.3 years mean follow-up, hospital admission rate was 1.4 ± 2.3 versus 1.1 ± 3.3 (P =.18), with 6.7 ± 18.3 versus 7.0 ± 43.0 in-hospital days, for DS and RYGB, respectively. An increased risk of malnutrition/malabsorption requiring inpatient care (2.8% versus.2%, odds ratio 12.3 [3.3–45.7]) and greater need for additional abdominal surgery (25.8% versus 15.3%, odds ratio 2.0 [1.5–2.7]) was observed for DS. However, QoL was more improved after DS. DS was associated with more early complications because of more open surgery, but long-term requirement of inpatient care was similar to RYGB. The increased risk of malnutrition/malabsorption and need for additional abdominal surgeries was contrasted with a greater improvement in QoL for DS. [ABSTRACT FROM AUTHOR]

The introduction and subsequent widespread adaptation of minimally invasive approaches for bariatric surgery have not only changed the outcomes of bariatric surgery but also called into question the management of co-morbid surgical conditions, in particular gallbladder disease. The American Society for Metabolic and Bariatric Surgery Foregut Committee performed a systematic review of the published literature from 1995–2018 on management of gallbladder disease in patients undergoing bariatric surgery. The papers reviewed generated the following results. (1) Routine prophylactic cholecystectomy at the time of bariatric surgery is not recommended. (2) In symptomatic patients who are undergoing bariatric surgery, concomitant cholecystectomy is acceptable and safe. (3) Ursodeoxycholic acid may be considered for gallstone formation prophylaxis during the period of rapid weight loss. (4) Routine preoperative screening and postoperative surveillance ultrasound is not recommended in asymptomatic patients. In the era of minimally invasive surgery, the management of gallbladder disease in patients undergoing bariatric surgery continues to evolve. • Gallbladder surgery is the most frequently performed procedure after bariatric surgery and may be more technically challenging. • Routine prophylactic cholecystectomy at the time of bariatric surgery is not recommended. • Mildly symptomatic patients with positive imaging studies may undergo concomitant cholecystectomy at the time of bariatric surgery, regardless of procedure. • Ursodeoxycholic acid can be used during the period of rapid weight loss to mitigate the development of symptomatic gallbladder disease after bariatric surgery. • Preoperative screening and postoperative surveillance ultrasound is not recommended in asymptomatic patients. [ABSTRACT FROM AUTHOR]

Unsatisfactory weight loss is common after bariatric surgery in patients with super obesity (body mass index [BMI] ≥50 kg/m2). Unfortunately, this group of patients is increasing worldwide. The aim of this study was to compare long-term weight loss and effect on co-morbidities after duodenal switch (DS) and gastric bypass (RYGB) in super-obese patients. University hospital, Sweden, national cohort. This observational population-based cohort-study of primary DS and RYGB (BMI ≥48 kg/m2) in Sweden from 2007 to 2017 used data from 4 national registers. Baseline characteristics were used for propensity score matching (1 DS:4 RYGB). Weight loss was analyzed up until 5 years after surgery. Medication for diabetes, hypertension, dyslipidemia, depression, and pain were analyzed up until 10 years after surgery. The study population consisted of 333 DS and 1332 RYGB, with 60.7% females averaging 38.5 years old and BMI 55.0 kg/m2 at baseline. DS resulted in a lower BMI at 5 years compared with RYGB, 32.2 ± 5.5 and 37.8 ± 7.3, respectively, (P <.01). DS reduced prevalence of diabetes and hypertension more than RYGB, while reduction in dyslipidemia was similar for both groups, during the 10-year follow-up. Both groups increased their use of antidepressants and a maintained a high use of opioids. This study indicates that super-obese patients have more favorable outcomes regarding weight loss and effect on diabetes and hypertension, after DS compared with RYGB. Propensity-score matched, national cohort of 333 DS and 1332 RYGB. DS resulted in a superior weight loss at 5 years. DS resulted in greater improvement in diabetes and hypertension, 10-year follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Up to 30 % of patients undergoing bariatric surgery are dissatisfied with treatment outcomes in the long term. The aim of this study was to examine overall satisfaction with treatment 5 years after bariatric surgery and its association with body mass index (BMI) and health-related quality of life (HRQOL). Methods: Patients were surveyed 5 years after bariatric surgery; 108 patients had duodenal switch (DS) and 153 patients had laparoscopic sleeve gastrectomy (LSG). The main outcome was overall treatment satisfaction, assessed by a single question, and analyzed by multiple logistic regression. Estimates for continuous independent variables represent the odds ratios (OR) for a 2-standard deviation difference. Results: Five years after surgery, 82.4 % of the patients were very satisfied or satisfied, whereas 17.6 % were unsure or dissatisfied. The following variables assessed at 5 years were associated with being dissatisfied/unsure: a higher BMI (OR = 6.1, 95 % CI = 2.7–14.0, p < 0.001), reduced obesity-specific HRQOL (OR = 3.0, 95 % CI = 1.1–7.8, p = 0.03), and reduced mental HRQOL (OR = 0.3, 95 % CI = 0.1–0.8, p = 0.02). We also found that a higher proportion of patients who underwent LSG, compared to DS, reported being dissatisfied/unsure (OR = 3.3, 95 % CI = 1.3–8.8, p = 0.01). Conclusion: Reduced mental HRQOL and obesity-related HRQOL, as well as higher BMI, were associated with less satisfaction with overall treatment outcomes 5 years after bariatric surgery. Differences in overall treatment satisfaction by type of operation warrant further investigation. [ABSTRACT FROM AUTHOR]

Duodenal switch (BPD/DS) is gaining popularity as a secondary procedure for inadequate weight loss after an initial operation. We aimed to generate expert consensus points on the appropriate use of BPD/DS in the revisional bariatric surgical setting. Data were gathered at an international conference with attendees from a variety of different institutions and settings. Sixteen lines of questioning regarding revisional BPD/DS were presented to an expert panel of 29 bariatric surgeons. Current available literature was reviewed extensively for each topic and proposed to the panel before polling. Responses were collected and topics defined as achieving consensus (≥70% agreement) or no consensus (<70% agreement). Consensus was present in 10 of 16 lines of questioning, with several key points most prominent. As a second-stage procedure, BPD/DS is most appropriate after sleeve gastrectomy (SG) for the treatment of super morbid obesity (96.7% agree) or as a subsequent operation for a reliable patient with insufficient weight loss after SG (88.5%). In a patient with weight regain and reflux and/or enlarged fundus after SG, Roux-en-Y gastric bypass is preferable and BPD/DS should be avoided (90%). BPD/DS should not be used prophylactically in patients with a history of jejunoileal bypass who are otherwise doing well (80.8%). Applicability of BPD/DS is limited by technical difficulty; 86.2% of experts would routinely recommend or consider the procedure if it were more technically feasible after failed bypass. No consensus was found on approaches to revision of BPD/DS for protein malnutrition. • As a revisional procedure, duodenal switch (BPD/DS) is most appropriate as a second-stage surgery after sleeve gastrectomy (SG) for the treatment of super-morbid obesity or as a subsequent operation for a reliable patient with insufficient weight loss after SG. • In a patient with weight regain and documented reflux and/or enlarged fundus after SG, Roux-en-Y gastric bypass is preferable and BPD/DS should be avoided. • BPD/DS should not be used prophylactically in patients with a history of jejunoileal bypass who are otherwise doing well. • As a revisional procedure for failed Roux-en-Y gastric bypass, applicability of BPD/DS is limited by technical difficulty; most experts would routinely recommend or consider the procedure if it were more technically feasible after failed bypass. [ABSTRACT FROM AUTHOR]

Highlights • This study compares the weight loss, laboratory values, and complications between SADI-S and traditional duodenal switch using retrospective chart review. Our findings show that the two procedures are comparable in terms of weight loss and complication rate. Abstract Background Biliopancreatic diversion with duodenal switch (DS) is known to be superior in weight loss to other bariatric procedures, but with the disadvantage of increased complication rates. Single-anastomosis duodenal-ileal bypass (SADI-S) is reported to have similar weight loss with lower complication rates compared with traditional DS. Objectives The aim of this study was to compare weight loss and complication rate between SADI-S and double-anastomosis DS at a single institution. Setting Academic hospital, United States. Methods A retrospective chart review was performed on 185 patients who underwent laparoscopic or robot-assisted laparoscopic DS between March 1, 2015 and December 10, 2017. A total of 111 patients had SADI-S, and 74 patients underwent double-anastomosis DS. Results Baseline patient characteristics were comparable between the 2 groups. The mean preoperative body mass index was 56.3 kg/m2 and 54.4 kg/m2 in SADI-S and double-anastomosis DS patients, respectively. Thirteen (11.7%) and 4 (5.4%) patients were readmitted within 30 days after SADI-S and double-anastomosis DS, respectively (P =.16). Percentage of total weight loss was 22.0%, 38.5%, and 44.2% in the SADI-S group and 20.2%, 38.0%, and 48.4% in the double-anastomosis DS group at 6, 12, and 24 months, respectively. The majority of patients had vitamin A and E levels in the normal range. However, 40% to 60% of the patients had low levels of vitamin D after the procedure. Conclusions SADI-S and double-anastomosis DS are comparable in terms of weight loss and complication rate. However, close nutritional follow-up is warranted for both procedures. [ABSTRACT FROM AUTHOR]

Background: With the increase in popularity of laparoscopic sleeve gastrectomy (LSG), the number of patients experiencing weight regain has increased as well. This study aims to demonstrate the outcomes of LSG conversions to Roux-en-Y gastric bypass (RYGB), double anastomosis duodenal switch (DS), and single anastomosis duodeno-ileal sleeve (SADI-S) due to weight regain.Methods: A retrospective chart review was performed on 21 patients who underwent a conversion of LSG due to weight regain between March 1, 2013, and April 30, 2017. A longitudinal analysis was performed for the body mass index (BMI) measures, using multilevel model for change.Results: Of 21 patients, 6 underwent a conversion to RYGB, 9 underwent a conversion to SADI-S, and 6 underwent a conversion to double anastomosis DS. Mean percentage of total weight loss was 16.0% at 6 months, 20.1% at 12 months, 18.8% at 24 months, and 21.8% at 36 months after the procedure. The final model suggests that preoperative BMI is the most significant indicator for initial status and the rate of change in BMI. Adjusting for preoperative BMI, type of procedure significantly affected the rate of change in BMI. The rate of decrease was fastest in RYGB patients, adjusting for preoperative BMI. One patient was readmitted 26 days after the conversion for pulmonary embolism and intraabdominal hematoma, and no patient required a reoperation within 30 days after the conversion.Conclusion: Conversions of LSG to RYGB, double anastomosis DS, and SADI-S are safe and can provide significant additional weight loss. [ABSTRACT FROM AUTHOR]

Case report of a phytobezoar causing gastric outlet obstruction as a late complication after biliopancreatic diversion with duodenal switch, review of the literature and discussion of bezoars as a differential diagnosis in patients after bariatric surgery presenting with signs of intestinal obstruction. [ABSTRACT FROM AUTHOR]

Patients who have undergone bariatric surgery present unique challenges in the acute care surgery setting. This review includes the presentation, workup, and management of most common bariatric surgery emergencies encountered by acute care surgery., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The majority of bariatric surgical stapling procedure concepts were developed prior to the understanding of obesity as an energy storage disease. Conventional treatments did not consider the impact of macronutrients on hormones and glucose variability. Current recommendations suggest diets low in glycemic load, with moderate protein and unsaturated fat. Roux-en-Y gastric bypass promotes glucose variability which can be harmful for health and encourage weight regain. Classic duodenal switch with short common channels may prevent absorption of measurable fat-soluble vitamins and frequently untested essential fatty acids. The purpose of this review is to discuss these factors and explain why single anastomosis duodenal switch reduces glucose variability, allows for absorption of critical fats and fat-soluble vitamins, and has potential to offer better weight loss and metabolic outcomes. [ABSTRACT FROM AUTHOR]